Objective: To prospectively assess real world experience with Caspofungin (C) administered as monotherapy or in combination therapy for initial or salvage treatment of proven or probable invasive aspergillosis (IA).

Methods: A prospective observational registry was developed to collect data from patients treated with C for a single episode of IA. Information was collected from Apr-06 to Sep-07. Clinical efficacy was determined by the local investigator as favorable (complete or partial) or unfavorable (stable disease or failure) at the end of C therapy (EOCT).

Results: One hundred and three consecutive patients with proven or probable IA (per EORTC/MSG criteria) were identified from 23 sites in 11 countries. Outcomes were assessed in 101/103 patients since 2 patients were not discharged from the hospital at study termination. The most frequent underlying conditions included malignancy (77%), allogeneic hematopoietic stem cell transplantation (HSCT, 20%), solid organ transplantation (SOT, 9%), autologous HSCT (8%), & HIV/AIDS (3%). Neutropenia at start of C was recorded in 57% cases. Eighty three patients (82%) were treated for probable IA. The majority (85%) of patients had pulmonary IA. In culture-proven cases, A. fumigatus was the most frequently isolated species followed by A. flavus. The majority of patients received C monotherapy (83%), primarily as salvage therapy (86%). Most salvage treatment (74.2%) occurred in patients refractory to prior antifungals. A favorable response at end of C treatment was seen in 56% (57/101) of patients with similar favorable outcomes for C used as combination therapy (56%; 9/16) or as monotherapy (57%; 48/85). Favorable response rates in significant subgroups were: malignancy 52% (41/79); allogeneic HSCT: 57% (12/21); neutropenia: 53% (35/66). Serious adverse events were reported in 4 cases (4%); only 2 patients (2%) discontinued treatment due to a drug related AE (respiratory failure & skin reaction). An overall survival rate of 73%(75/103) was observed at the EOCT.

Conclusions: In daily clinical practice, an overall favorable response rate of 56% was observed in patients with proven or probable IA treated with C monotherapy or combination therapy. Also, a favorable response rate of >50% was seen in high-risk patient sub groups, including those with malignancy, allogeneic HSCT, and neutropenia. These real-life findings are consistent with the findings observed in randomised clinical trials.

Session Details

Date:

19/04/2008

Time:

00:00-00:00

Session name:

18th European Congress of Clinical Microbiology and Infectious Diseases